Documents for Health Claim

Critical Illness Claim, ICICI Pru Heart / Cancer Protect Claim, Major Surgical Assistance Benefit Rider Claim, Accidental Death Benefit Rider or other Rider Claim

To report a claim you will need the following documents:

  • Claimant's statement / claim intimation form - Download Form Download Icon
  • Attending doctor's certificate
  • Copy of medical records (admission notes, discharge summary and test reports)
  • Original policy certificate
  • Cancelled cheque

Fixed benefit hospitalisation claim for ICICI Pru Hospital Care or ICICI Pru Hospital Care II

You will receive a sum as Fixed Benefit* for the number of days you were admitted in a hospital or type of surgery grade under the ICICI Pru Hospital Care and Hospital Care II policies. For reporting Fixed Benefit Hospitalisation claim, you will need the following documents:

  • Claimant's statement / claim intimation form - Download Form Download Icon
  • Copy of medical records (admission notes, discharge summary and test reports)
  • Pre-authorisation form (for cashless facility) - Download Form Download Icon
  • Attending doctor's certificate
  • Health check-up form (for ICICI Pru Hospital Care II) - Download Form Download Icon
  • Cancelled cheque

Indemnity Hospitalisation Claim applicable for ICICI Pru MediAssure or ICICI Pru Health Saver:

For the expenses made for hospitalisation and other related medical costs*, you will be compensated under the Indemnity Hospitalisation claim. For reporting this claim, you will need the following documents:

  • Claimant's statement / claim intimation form - Download Form Download Icon
  • Original discharge card
  • Original investigation reports
  • Health check-up form (for ICICI Pru Health Saver) - Download Form Download Icon
  • Original hospital/ pharmacy bills and payment receipts and records
  • Pre-authorisation form (for cashless facility) - Download Form Download Icon
  • Health saving benefit form (for ICICI Pru Health Saver) - Download Form Download Icon
  • Cancelled cheque

*Please read your policy document for further details.
**A rider is an extra benefit that can be purchased along with your policy for increasing your cover. Comp/doc/Jan/2018/0777.

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